Does 81558 require prior authorization?

No, 81558 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 81558?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

For Part A UB04 paper claim forms, enter the DEX Z-Code adjacent to the CPT code in Block 80.
For Part B electronic 5010A1 837P claims, enter the DEX Z-Code adjacent to the CPT code in Loop 2400 or SV101-7.
For Part B paper claims, enter the DEX Z-Code adjacent to the CPT code in Box 19 of the paper claim form.
For Part A electronic 837I claims, enter the DEX Z-Code adjacent to the CPT code on line SV202-7.

To report a Molecular Diagnostic Test (MDT) service, submit the appropriate CPT code, include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field, and enter 1 unit of service (UOS).
Molecular testing for detection or monitoring of solid organ allograft rejection is covered when the patient and clinical situation meet the coverage criteria of the referenced MolDx LCD/policy.
AlloMap (CareDx) gene expression profile performed on blood is covered for surveillance/assessment of heart transplant rejection when coverage criteria are met.
AlloSure (CareDx) targeted NGS measuring percent donor-derived cell-free DNA from blood is covered for assessment of kidney, heart, and lung transplant injury/rejection when coverage criteria are met.
AlloCare (CareDx) AlloSure Heart plus AlloMap Heart performed on the same blood sample is covered for heart transplant assessment when coverage criteria are met.
Prospera (Natera) multiplex PCR–NGS measuring percent donor-derived cell-free DNA from blood is covered for assessment of kidney, heart, and lung transplant injury/rejection when coverage criteria are met.

A57772 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

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A58207 — Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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L38680 — MolDx: Molecular Testing for Solid Organ Allograft Rejection

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Ask Verity about documentation requirements, denial risks, or coverage in your state.